technology

Carol’s Corner—Disconnect to Connect

I’m of the generation that remembers telephones having “party lines” (an early network?).

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And receiving letters delivered by the USPS mailman. How thrilling to receive a piece of mail with your name and address handwritten on the envelope!

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And get-togethers with multiple generations seated at a long table erected by Grandpa from sawhorses and sheets of plywood.

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More recently, breaks at work spent chatting with coworkers.

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Many of these ways to keep in touch with family and friends were limited by technology, time, and distance. You didn’t know what someone looked like or how their appearance had changed unless a photograph was included with the letter. Calls to different time zones had to take into account others’ schedules or, in the extreme, making an appointment for a call to the one phone in a village. Even with constraints, people remained connected.

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As time has passed and technology evolved, the constraints have been batted to the side! Families can communicate any time, any place. The first time I arranged for my husband to Skype with his sister in Europe, I had to reschedule! Sitting in front of the computer, I remembered that she hadn’t seen me in 5 years and it might be a good idea to take a shower, blow dry my hair, and change from my pj’s. That done, the joy and amazement on their faces were wondrous.

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The advancements in technology are amazing and we’re all connected! Pause. Are we?

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I’m not wishing for the “good ol’ days.” Even though I still have a “stupidphone” and it is not always turned on, there are many devices and software that are great and add to the enjoyment of life.

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But picture these scenarios—

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A mother (or father) and two children at a table in a restaurant. Are they chatting about what’s happened during the day or their plans for the weekend? Or has the smartphone become the parent’s focus of attention?

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A family gathering where one or more persons are checking texts, e-mailing, etc. on devices and ignoring others around them.

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When you hear a news stories about places to stay for “digital detox” you think it might be directed at you.

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Breaks at work where eyes are on small screens and coworkers aren’t talking with each other.

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Pedestrians bumping into passers-by or poles.

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You are more “involved” with checking Facebook as a voyeur and have not spoken with those people in months or have a tendency to ignore others in your household.

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If you are part of these scenarios, disconnect so that you can connect!
Unplug it—Put it away—Turn it off
Use technology to add to your life, not to isolate you from others and your surroundings.

Published just a few months ago, Gary’s book addresses all that has changed in the world of diabetes in recent times, bringing readers up to date on changing technology, therapies, and approaches to diabetes management. He discusses the latest developments in pump technologies, diabetes medications, lifestyle considerations such as diet and exercise, and current attitudes about treatment and care.

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Each chapter includes “on the rise” and “on the decline” sections, helping readers learn what to keep an eye on and what to consider phasing out of their treatment plans. I checked in with Gary to talk about what’s been going on in the diabetes world since his book was published in February, and here’s what he has to share with you.

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KP: Gary, do you think that medications that try to prevent the disease will ultimately be successful? What about immune-system blocking drugs?

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GS: I’m somewhat skeptical about the immune system blockers, first because of the side effects and second because the human immune system is so darned complex and difficult to work around. Seems that every medication that has been developed either doesn’t work long-term or works too well, resulting in side effects that are worse than the diabetes was in the first place. A highly selective immune blocker that protects the beta cells would be the Holy Grail.

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KP: There’s been a lot in the news recently about adult stem cells and T1—how do you feel about the future of that research?

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GS: I’m a fan of any form of therapy that provides life-improving treatments … including stem cell research. Most people don’t realize that stem cell research almost never involves unborn fetuses; it’s received a lot of bad press by people who don’t understand the origin of the stem cells.

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KP: What about hardware? Anything new recently?

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GS: I don’t think there’s been much since the book came out. The Dexcom G4 has taken over as the continuous glucose monitor (CGM) we’ve all been waiting for, and insurance coverage has really improved. The new Asante Pearl pump has a lot going for it as it begins its rollout in the eastern part of the United States. There are a few new downloadable software programs and mobile device apps, but nothing that has revolutionized the industry.

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As a Certified Diabetes Educator and person living with diabetes for more than 25 years, Gary Scheiner, MS, CDE, has received numerous awards for his work in the fields of diabetes care and self-management teaching. Scheiner has written six books and hundreds of articles on various topics in diabetes wellness. Additionally, he teaches the art and science of blood glucose balancing to people throughout the world from his private practice in Wynnewood, Pennsylvania, USA.

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Katherine Plumhoff joined the Spry Wellness Blog as a contributor in 2013. She is currently pursuing her undergraduate degree in English and Communication Studies at the University of Michigan and hopes to work in publishing after graduation.

Essentials of Robotic Surgery details the history of robotic surgical technologies and techniques, while looking ahead to the possibilities contained within future applications. Covered in the book are the most notable, current surgical applications, from coronary revascularization to prostate surgery, from the lungs and esophagus to the uterus, from sleep apnea to head and neck cancer.

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Surgical robots currently are used to perform a wide range of procedures across a diverse group of specialties, and they have proven to exhibit a number of significant advantages over manual surgeries, including increased precision, less blood loss and pain, and shorter recovery times. Essentials of Robotic Surgery is an ideal resource for healthcare professionals who are considering whether robotic surgeries may be right for their organization, as it provides the most up-to-date information currently available on this highly dynamic topic.

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In a recent interview, Essentials of Robotic Surgery editor Dr. Manak Sood discussed the future of robotically assisted surgery and some of the premise behind his new book. “Robotic surgery is penetrating almost seven different specialties. There are more and more applications for the technology in each specialty as time goes on. There are new robots coming out, they’re going to be smaller and better, so this technology is definitely here to stay. The better we get at it, the more we can do with it.”

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Coeditor Dr. Stefan W. Leichtle echoed Dr. Sood’s enthusiasm by saying, “I think surgical robotic systems have already shown that they are more than an expensive toy or a fascinating piece of technology, and that they can provide a real benefit measured in quality of life for certain patients. Robotic surgery often creates emotional responses because of the current discussions about cost and value of medical care. Though that is very important, I’d recommend that even skeptic readers should be open to being fascinated and excited about this amazing technological advancement.”

About Manak Sood, MD
Manak Sood, MD, received his medical degree from Albany Medical College School of Medicine in 1992. He completed his residency at St. Barnabus Medical Center and attended Indiana University School of Medicine for his fellowship in thoracic surgery. Dr. Sood specializes in cardiothoracic surgery and is board certified by the American Board of Thoracic Surgery. He currently practices at the Michigan Heart & Vascular Institute (MHVI) of Saint Joseph Mercy Health System.

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About Stefan W. Leichtle, MD
Stefan W. Leichtle, MD, is currently a senior resident in General Surgery at Saint Joseph Mercy Health System in Ann Arbor, Michigan. He received his medical degree at the Technical University Munich after attending the Universities of Erlangen-Nuremberg and Munich in Germany. Dr. Leichtle’s scholarly interests include healthcare policy and outcomes research. He is actively involved in local and regional quality improvement initiatives, and has published several scientific manuscripts. Additionally, Dr. Leichtle has received numerous awards for regional and national presentations of his research. Clinically, he is interested in trauma surgery and surgical critical care, and is actively involved in trauma education and quality improvement.

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About SPRY PUBLISHING
Spry Publishing is a premier publisher of health books and media, offering valuable content on a wide range of medical subjects. With an extensive list of accredited authors, Spry Publishing specializes in educating both patients and healthcare professionals by delivering timely, relevant wellness information across an array of platforms.
Spry Publishing operates within the Edwards Brothers Malloy family of businesses, a century-old printing and publishing tradition that is currently the sixth largest book and journal manufacturer in North America.

Diabetes Tips from Gary Scheiner’s New Book

As Gary says, “This book is all about keeping pace with the changes—changing technology, changing therapies, changing approaches to diabetes management. Basically, the information provided here will help you take advantage of what’s ‘new and improved,’ and ultimately make your diabetes control a little bit better and living with this chronic condition a little bit easier. My personal goal, and what I emphasize to my patients, is to take the best possible care of their diabetes here and now. When a cure does finally come along—and it will—I want to be in the best of health and have no regrets about the effort I put in.”

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To celebrate this upcoming book, we will be releasing a series of ‘DTips’ over the next few weeks. We’ll share short bits of useful information with you on the future of diabetes, excerpted from the pages of Until There Is a Cure. Watch for #DTips on Twitter and don’t miss the next one!

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Gary Scheiner’s Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care releases on February 26, 2013. Preorder your copy now!

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After earning a Master of Science in Exercise Physiology, Gary Scheiner, MS, CDE, received his diabetes training at the Joslin Diabetes Center. As a Certified Diabetes Educator and person living with diabetes for more than 25 years, he has received numerous awards for his work in the fields of diabetes care and self-management teaching.

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

First Peek at “Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care”

Gary Scheiner MS, CDE , knows a thing or two about diabetes. Not only has he managed his own type 1 diabetes for more than 20 years, but he has also devoted his life and career as a Certified Diabetes Educator to educating and empowering others living with diabetes, helping them to truly understand their conditions and their treatment options. He is tremendously skilled at taking difficult medical concepts and communicating them in a way that virtually anyone can understand—an important, if not crucial, qualification in Gary’s line of work.

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Gary’s widely read books are staples in any serious diabetes library, with his Think Like a Pancreas frequently topping best-seller lists and adorning the bookshelves of both patients with diabetes and health-care professionals everywhere.

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In his newest book, Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care , Gary shares insider information on forthcoming, groundbreaking advancements in diabetes research, technology, and treatments. The following excerpt captures Gary’s enthusiasm for helping people with diabetes and explains some of his overall concept behind writing the book.

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I never used to believe in that saying, “The more things change, the more they stay the same.” Then I entered the diabetes field.

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This book is all about keeping pace with the changes—changing technology, changing therapies, changing approaches to diabetes management. Basically, the information provided here will help you take advantage of what’s “new and improved,” and ultimately make your diabetes control a little bit better and living with this chronic condition a little bit easier.

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With changes taking place all around us, what exactly has stayed the same? For starters, the goal of diabetes management is roughly the same: to manage blood sugar as effectively as possible so that it does not keep us from enjoying life to the fullest. The emphasis on self-management hasn’t really changed. Experts recognize that diabetes is the type of condition that involves countless choices and decisions on the part of the patient on a daily basis. To expect your doctor or nurse to be there all the time is a pipedream. We, as people with diabetes, must educate ourselves and obtain and use the necessary tools to manage effectively.

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One other constant through the years is hope. We all hope that doing the right things will produce the desired results. We also hope for a cure. Back in 1985 when I was diagnosed with type 1 diabetes in a Texas town called Sugarland (God’s honest truth!), my endocrinologist tried to convince me how lucky I was to be diagnosed when I was.

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“We’ve come a long way in recent years,” he said. “The way research is going, in five or ten years, your diabetes will probably be cured.”

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That was more than 25 years ago. Still no cure, but people are still saying, “In 5 or 10 years … we’ll have a cure.” Although there is some very promising research taking place, I’m not one to put my eggs in that basket. My personal goal, and what I emphasize to my patients, is to take the best possible care of their diabetes here and now. When a cure does finally come along—and it will—I want to be in the best of health and have no regrets about the effort I put in.

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Today, I can look back at the way diabetes was treated when I was diagnosed and say, “Man, those were the Stone Ages!” But you know what? Five or ten years from now, I’ll probably look back to today and think the very same thing. At least I hope so.

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Gary Scheiner’s Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care releases on February 26, 2013. Preorder your copy now!

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

The Insider’s Info on Cholesterol

There is nothing exotic or romantic about cholesterol—a waxy, fat-based substance that determines our cardiovascular health risks. Then why is it that cholesterol is the topic of dinner conversations and long walks on the beach? I think it is because of the idea that cholesterol is something we can impact or change. As a dietitian, there is no greater thrill than to see the results of my clients’ hard work revealed in the lowering of their cholesterol. By focusing on four main areas of your diet, you can put the “les(s)” back in cholesterol and improve your complete health profile.

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Cholesterol is manufactured in your liver, so it makes sense that when we eat animal-based foods there is going to be cholesterol in them—because those animals’ livers make cholesterol too! Our own livers make up to 4,000 mg of cholesterol per day, so it is important that we limit the amount of cholesterol we get in our diets. The American Heart Association recommends that cholesterol intakes be limited to less than 300 mg per day. To put that number in perspective, 1 egg has 213 mg of cholesterol (all of which is in the yolk), and one 4-ounce hamburger has about 100 mg of cholesterol. To see a complete list of the cholesterol content in common foods visit this link. A great way to decrease your daily cholesterol intake is to change a couple of meals each week from animal-based meals to vegetable-based ones. Several studies have confirmed that following a vegetarian or vegan diet helps to keep cholesterol levels in a desirable range.

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Total caloric intake impacts our cholesterol more than most people think. Overconsumption leads to weight gain, and we know being overweight increases our cholesterol and risk for heart disease. Most adults require between 1500 and 2500 calories per day, depending on gender, height, weight, age and activity level. Great websites including calorieking.com and myfitnesspal.com allow you to determine and track your target daily caloric intake, thus helping you to keep calories in check each and every day.
Fitting in fiber is essential to keeping cholesterol levels low. Fiber is helpful in this area in two main ways. First, fiber plays a unique role in the small intestine where it literally binds to cholesterol in the food that we have eaten and helps to excrete that cholesterol before it ever enters our blood stream. The fiber content in foods like Cheerios and Quaker Oatmeal is what allows them to boast about their ability to lower your cholesterol. Secondly, fiber helps to keep us feeling fuller for longer, thus reducing our daily intake and cravings for sweets. Adults need 25-35 mg of cholesterol each day. Children need 5 plus their age in grams of fiber each day. Fiber intake should be spread throughout the day and be included in part of each meal. Fiber is found naturally in foods like whole grain breads, cereals, pastas, rice, fruits, vegetables, beans, lentils and popcorn.

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Last but certainly not least is the requirement to change the types of fats you include in your daily diet. There are fats that are actually good for us. Those are the ones that help to keep your HDL (happy cholesterol) high, while keeping your LDL (lousy cholesterol) low. The types of magical fats that I am referring to are monounsaturated fats and a certain type of polyunsaturated fats called omega-3 fats. These fats, found in olive oil, canola oil, avocados, nuts, fish and flaxseed, should be included in small servings two to three times each day. Other fats, including saturated fat (butter, high-fat dairy, and meats), and trans-fats (margarine and processed liquid vegetable oils) negatively impact our cholesterol by making our total cholesterol and our LDL cholesterol go up. Many Americans were raised putting butter on everything. While removing butter from your daily routine may seem like a daunting task, rest assured that your taste buds will adapt. In fact, it only takes your body about three weeks to adjust to a new way of eating.

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There are very few things in life that we actually have control over. While some people have a genetic predisposition toward high cholesterol, the majority of us can control our cholesterol and should feel empowered to do so. After all, the only thing less romantic than cholesterol to talk about is a heart attack.

When Should You Get a Mammogram?

Many women begin to receive mammograms at age 40, however, new research is causing a controversy within the medical community over when women should begin to receive annual or biannual mammograms. There are two opinions: one group is continuing to recommend that annual mammograms begin at 40, while the other group is advocating for an initial assessment at 40 which will then direct a personalized assessment of how often the woman should receive mammograms. Both sides are attempting to provide the most complete care for women by focusing on two different aspects of the diagnosis process.

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The first group of doctors is continuing to encourage an annual mammogram, preferring to err on the side of health versus harm. Even though the risk of developing cancer between the age of 40 and 49 is about 1%, women with a family history of breast cancer are at a much more significant risk of developing cancer. The time between when a cancerous growth begins and when it shows symptoms is called the sojourn time. For women in their 40s, that time is 2-2.4 years. So, if a woman does not receive annual mammograms and does have a cancerous growth, she may not have symptoms until it has been growing for 2 years. Since the 5-year survival rate is 98% for breast cancer that is caught early enough, doctors think that the few women who do develop breast cancer in their 40s may discover it early enough to experience the highest possible 5-year survival rate, if they receive annual screening. By screening all women over 40 annually, the one percent of women who do have breast cancer is given a much higher chance of survival.

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However, most women in their 40s who are told that they have a suspicious lump end up having a “false positive,” a growth that is not cancerous. Some healthcare providers think that the emotional stress of a false positive and the radiation from the x-ray are not worth the cost of an annual screening until the women are 50.

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Many who feel that the emotional stress and financial cost of annual mammograms at 40 are more damaging than previously indicated are now advocating that women should have an initial assessment at 40 to determine a personalized recommendation. This recommendation would be based on factors such as breast tissue density and family history. The breast has both glandular and fatty tissue, and women with more glandular tissue (or more dense tissue) exhibit growths that are more difficult to see on the x-ray. A woman with higher-density tissue and a family history where a first-degree relative, such as mother or sister, has had breast cancer may be recommended to have annual exams due to greater risk factors. However, a woman with low breast density and no family history of breast cancer may only need a mammogram every 3-4 years until she turns 50.

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Dr. Diana Petitti who has worked on the US preventative Services Task Force study says, “Personalized breast screening recommendations are better.” Talk with your doctor about your family history and your wishes in order to form the best healthcare plan for you.

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

Meet Gary Scheiner

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Gary Scheiner MS, CDE has graciously agreed to share some of his thoughts with me this week. His upcoming book, Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care, is a guide to the most recent advancements in the world of diabetes care that will be hitting stores next February. I talked with Gary about what motivated him to pursue a career in diabetes education, why he thinks quality information is essential for people with diabetes, and who he is outside of the his practice.

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Can you tell us a little bit about yourself?
I’m 45 years old and live just outside Philadelphia. I am a big sports fan (Phillies, Sixers, Eagles), love to play basketball, run, lift weights and bike. I have four kids (Marley-17, Jackie-15, Benjamin-12, Nalani-9) and have been married to Debbie for 23 years.

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What made you want to do what you’re doing?
Living with diabetes 24-7 and seeing others struggling with it gives me the drive to be in this field. It certainly ain’t the money! (Nobody is getting rich providing diabetes education.)

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I’ve had T1 diabetes since I was 18. I was actually diagnosed in SUGARLAND, Texas—the irony is unbelievable. I use an insulin pump, CGM, and take Amylin/GLP-1 to manage hunger and post-meal spikes. My control isn’t always the greatest, but I do the best I can.

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Why did you feel you had to share the information in your book?
Far too many people with diabetes are, shall we say, “underserved” by their healthcare providers. Many physicians are not up to speed on the latest technologies and are intimidated by them. As a result, their patients are not exposed to devices and techniques that could be benefitting them greatly.

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What is your favorite piece of information that you share in your book and why?
I think my favorite sections are the updates on new technology for monitoring blood sugar and delivering insulin.

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What tips or advice would you share with your readers?
New medications, technologies, and techniques are useless unless you have the self-management skills to utilize them effectively. Take the time to work with diabetes educators on honing your skills and using the latest tools to achieve the best possible control.

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How important is it that a person with diabetes keeps up with technology?
It is important, simply because it makes our lives—and I say “our” because I have diabetes as well—easier and our control better. However, technology without proper education and motivation to use it optimally is a grand waste of time.

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How have concepts of blood glucose management changed?
We no longer need to mold a person’s lifestyle around their insulin program. We now mold the insulin program around the chosen lifestyle. PWDs can do just about anything they choose to do, as long as they have the tools and insight to match their insulin to the situation.

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What trends are you seeing in CGMs and other management technologies right now? Do you think they will last?
The comfort, accuracy and ease of use continue to improve with each newly released system. But more importantly, third party payers are accepting this technology and are much more willing to cover the costs. Without coverage, CGMs and other technologies would go nowhere.

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How does your family feel about the book?
This is my 6th book, so they just know that I’m doing what I like to do—writing and educating people with diabetes.

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What do you do when you are not writing?
My practice, Integrated Diabetes Services, keeps me pretty busy. We have a team of CDEs who work with insulin users to enhance their self-management skills and achieve the best possible control. Our clients are worldwide, since we offer our services remotely through the phone and online.

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What’s in your CD collection?
Not much from the last couple of decades. I’m into Stevie Ray Vaughan, AC/DC, Led Zeppelin, and Brian Setzer. When my wife is with me, we enjoy Billy Joel, Meatloaf, and the B-52s.

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What else would you be if you weren’t working with people with diabetes?
I think I’d be a good “laziness cop.” I’d issue tickets to people who don’t walk up/down a flight of stairs, wait for a parking spot right by the entrance, stand on moving walkways, etc… It always bothers me to see out-of-shape people using modern conveniences to excess.

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What do you wish people would ask you about more?
My kids! They’re all talented and special in their own unique ways, and I’m uber-proud of them. Don’t get me started.

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

The Evolution of Medicine: Part V

Hippocrates was Greek physician born around 460 BC. He is credited with changing our understanding of both disease and the role of the physician.

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No longer would gods and demons be the source of disease, and no longer would the physician function like a priest, accountable only to the gods. Rather, Hippocrates located disease within the human body and he made physicians accountable to their patients for honesty, integrity, and the avoidance of harm.

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Hippocrates believed that there were four “humors” in the human body: blood, yellow bile, black bile, and phlegm. Health was achieved by having these four humors in balance; illness resulted when they were out of balance. Thus, the role of the physician was to restore balance and he did so by bleeding patients, purging them (making them vomit), giving them enemas, using hot/cold baths and compresses, and using herbs. Hippocrates also began to record his observations and to perform some surgical treatments. Though his ideas about humors seem strange to us today, at the time they revolutionized concepts about health and illness.

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Fast-forward another 300 years to the Greek-Roman physician Galen, who was born approximately 129 BC. Galen used Hippocratic theories and became personal physician to several Roman emperors. His era was marked by widespread violence, from wars to gladiatorial events. As a result, physicians became excellent trauma surgeons and got to study human anatomy first-hand. The emperors forbade dissecting human corpses, but physicians gained further knowledge of anatomy by dissecting animals in addition to making observations while performing surgery.

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It would be about another 1,900 years until the role of germs would be properly understood, so many people died from surgical infections in Galen’s time—and that’s to say nothing of plague, pestilence, and poor hygiene. But the idea that having humors out of balance caused disease retained credence well into Renaissance times and as recently as the American Revolution.

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Ideas from Hippocrates and Galen marked a turning point in the long march toward a scientific, professional basis for medical practice. Gone were incantations, divination, and offerings to the gods. The humors may be little more than humorous to us now, but the Oath attributed to Hippocrates, the Father of Medicine, is still invoked by physicians today.

John Zettelmaier, MD is a graduate of the University of Michigan Medical School, a member of the Beta Beta Beta Biological Honor Society, an American Board of Family Practice Diplomate, an American Academy of Family Physicians Life Member and Fellow, and a Life Member of the Michigan Academy of Family Physicians.

The Evolution of Medicine: Part IV

Wars, commerce, and travel in ancient times brought physicians from one culture to the next. Let’s move from Egypt to Italy in a time before the Roman Empire.

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Anthropologists, archeologists, and historians place the Etruscan civilization in an area located in Western Italy. The Northern border was at the Arno River—current cities on the Arno are Pisa and Florence. The Southern border lay at the Tiber River—a current city there would be Rome. The Eastern border was the Apennine mountain range, while the Ligurian and Tyrrhenian Seas marked the Western border.

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Archeological excavations there have unearthed terra cotta statuettes of a helmeted goddess and vases with inscriptions to MENERVA. As the presiding divinity at that time, Menerva was worshiped as a healing goddess, a protectress of fertility, and perhaps an oracular deity. Bronze, votive statuettes of owls (considered a sacred bird to Menerva), sheep’s livers, and human anatomical body parts (heads, eyes and legs) were also found in excavated sanctuaries in this area. Many of these archeological discoveries are currently exhibited at the National Archeological Museum of Florence.

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The findings indicate that the Magical-Sacral concept was still the operating paradigm of medicine, even over two thousand years after Imhotep’s time. The goddess Menerva was probably also the Greek goddess Minerva, since there are many indications of correlations between Etruscan and Greek civilizations. Thus, long before modern forms of transportation and communication, medical and religious concepts were able to travel very long distances in the ancient times.

John Zettelmaier, MD is a graduate of the University of Michigan Medical School, a member of the Beta Beta Beta Biological Honor Society, an American Board of Family Practice Diplomate, an American Academy of Family Physicians Life Member and Fellow, and a Life Member of the Michigan Academy of Family Physicians.

Five Things to Remember in Your Child’s 504 Plan

For parents of a child with physical or mental impairments, the beginning of the new school year can be a good time to review and update their child’s 504 plan with his or her school. For other parents, this may be a time to draft their first 504 plan for a child who has been recently diagnosed with a condition that requires special support or accommodations. (For more information about whether a 504 plan would be appropriate for your child, visit the U.S. Department of Education’s FAQ.)

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By writing a 504 plan, parents are able to ensure that their child is supported and provided for at school in a way that is most beneficial to his or her education. While Section 504 covers any student with a physical or mental impairment, children with diabetes have a unique set of needs that impact not only their ability to be productive at school, but also their health and safety to the greatest possible degree. Author and diabetes advocate Leighann Calentine discusses her experiences with writing a 504 plan for her daughter after she was diagnosed with type 1 diabetes:

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“Putting the 504 in Place
Either before your child enrolls in school, or shortly after diagnosis if she or he is already in school, you will sit down with the school personnel who oversee 504 plans and begin the process. While many families want the 504 plan in place the instant their child walks through the school doors, in reality it often takes months to get the plan in place. In fact, we chose to put guidelines for Q’s care in place and not formalize her 504 plan until several months into the school year because we wanted to see what issues might arise that should be addressed.

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504 Plan Considerations
1. Location for Pre-Lunch Testing: School will provide an appropriate location for daily pre-lunch blood sugar testing and for lunchtime insulin by injection or pump.
2. Access to Bathroom and Water: Child will be allowed unrestricted access to the bathroom, water fountain/ water bottle, snack, and the office when she is not feeling well. Child may carry water and extra glucose sources.
3. Testing: Glycemic conditions can have an effect on the child’s testing, therefore: 1) blood sugar should be tested before important tests; 2) child needs to eat her regularly scheduled snacks even if they are during a test; 3) if diabetes-related activity (testing blood, snack, water, bathroom) must take place during a timed test, child will be given equivalent extension of time at the end of the test.
4. Lockdown Situations: Child will have blood sugar meter and snacks in an additional location that is accessible during a lockdown.
5. Attendance: Absences for diabetes-related medical appointments will not count against the child’s attendance record.

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It is easier to add items when you first set up the 504 plan rather than try to add them later. A 504 plan is a fluid document, and you should be able to make changes at any time. If you have a change in care routine, such as changing from MDI to a pump, it is important to modify your 504.”

The Evolution of Medicine: Part III

There is a long history of subdivisions or medical specialties in medicine. In my previous article we discussed Imhotep the magician-physician, minister of state, architect, chief priest, sage, scribe, and astronomer. Imhotep was the vizier to the Pharaoh Zoser. When Imohotep died, the sick flocked to the temple over his grave and after a millennium or two, Imhotep became a major deity himself (ca. 525 BC). Physicians were accorded great status in ancient cultures.

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During that ancient period another physician became prominent. This physician was Iri. Iri was known as the Shepherd of the Anus (or the Keeper of the Bottom). Thus, the specialty of proctology was born. As “Keeper of the Royal Rectum,” he became the first recorded enema-maker.

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The ancient Egyptians believed that the various parts of the body were governed by specific gods. During Iri’s time it was thought that the enema was ordained by the god Thot.

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Since every part of the body had its own god, it is easy to see how physicians then started to specialize in a particular organ and became devotees to the god of whichever body part they treated. Priest-physicians thus specialized in the specific god as well as the specific organ. The priest-physicians performed specialized examinations and used specific incantations, “holy water,” therapeutic dreams, enemas, bleedings, organ readings, and various food or fasting regimens.

John Zettelmaier, MD is a graduate of the University of Michigan Medical School, a member of the Beta Beta Beta Biological Honor Society, an American Board of Family Practice Diplomate, an American Academy of Family Physicians Life Member and Fellow, and a Life Member of the Michigan Academy of Family Physicians.

Cyber Bullying

My little sister frowned as she leaned over her laptop. “That’s weird. Jenn doesn’t usually talk like that.”

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I leaned over to see a chat message quickly filling up with profanity and insults. “Text her and see what’s up,” I suggested.

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A few moments later, Jenn called my sister in a panic. “My account must have been hacked. What’s happening? I hope not everyone can see this!” Fortunately for Jenn, her problem was quickly resolved–several boys from school had wanted to pull a prank. Many other teens are bullied in much more hurtful and damaging ways than Jenn, however.

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Cyber bullying comes in a variety of forms, many of which are similar to physical bullying, and others are only possible because of the internet and cell phones. People who are cyber bullied could receive threats of all kinds, inappropriate or threatening sexual remarks, derogatory labels, or be ganged up on in a public space such as a chat room or a Facebook wall. A teen may also be impersonated in ways that could be humiliating.

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Twenty percent of teens from 12-17 feel that people are “mostly unkind” on social networks. Between 32 and 43 percent of teens report being bullied online. Thirteen percent of teens have reported having an experience online that made them nervous to go to school the next day.

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Interestingly, when teens see someone being unkind online, 55% of the time they report that other users just ignore what is going on, 27% of the time they report seeing someone defending the victim, 20% of the time they see someone telling the offender to stop, and 19% of the time people join in the bullying.
Just because teens don’t speak up to bullies directly doesn’t mean that they aren’t concerned by what they see on social websites. Thirty-six percent of all teens who have witnessed online bullying have gone to another resource to get help about what to do. Teens that have a history of being bullied are more likely to seek advice about how to handle a cyber bullying situation than teens who have not been bullied.

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Parents and caregivers should be ready to respond to cyber bullying as online social networking becomes increasingly popular. OnGuardOnline.gov has some tips for parents on how to advise their children to use the internet safely and wisely. The site recommends reminding teens that once something is posted or sent, it cannot be taken back.

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Keep communication open with your children about how they spend their time on the internet and encourage them to respond responsibly to bullying situations that they may experience. With a little more education and awareness, it may be possible to reduce the number of children hurt by bullying each year and to equip students to intervene sooner when it does happen.

Five Ways to Avoid Phishing Scams

Here at Spry Publishing we are usually concerned with your physical health and well-being, but in this piece we are going to look at maintaining a peace of mind by keeping your information safe on the internet.

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Let’s face it, the internet is everywhere. It’s in your pocket, on your desk, in your purse, in your child’s room, waiting at your office. Sound a little creepy? The internet is used by nearly two billion people, and while most of them are kind, there are others who have one goal in mind–scamming you.
Many online scams are created in order to take your personal information or money, which is called phishing. The FBI’s internet crime complaint center estimates that 560 million dollars have been scammed from innocent, trusting people.

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While there are thousands of online scams, many fall into the same categories. These scams may come in the form of emails, pop-ups, advertisements on a sidebar of a website, or through entire fake websites. Many of these scams advertise offers to work from home, diet pills for incredibly low prices, international lottery winnings, mystery shopper jobs, fake apartment rentals, debt relief, and of course, the “Nigerian” individual asking for your help.

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While many people are becoming more aware of internet scams, the number of people getting scammed is still increasing. This is because scammers are getting better at looking like legitimate companies and profiting off of the victim’s altruism, hope for a healthier lifestyle, or desire to leave financial insecurity behind. OnGuardOnline cautions:

2. The messages may appear to be from organizations you do business with–banks, for example. Don’t reply, and don’t click on links or call phone numbers provided in the message. These messages direct you to spoof sites–sites that look real but whose purpose is to steal your information so a scammer can run up bills or commit crimes in your name.

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3. Only provide personal or financial information through an organization’s website if you typed in the web address yourself and you see signals that the site is secure, like a URL that begins “https.” The “s” stands for secure.

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4. Area codes can be misleading too. Some scammers ask you to call a phone number to update your account or access a “refund.” But a local area code doesn’t guarantee that the caller is local.

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5. If you’re concerned about your account or need to reach an organization that you do business with, call the number on your financial statements or on the back of your credit card.
Be aware of what is legal in your country. Always verify the website and remember not to give out personal information via email, no matter who the sender appears to be.

The Evolution of Medicine: Part II

Imhotep first used the word “brain.” It was described in the Edwin Smith Papyrus. It was written in an Egyptian cursive form of hieroglyph. The papyrus detailed eight magic spells as well as a description of 48 cases of injury. The patients were provided by the many wars during Imhotep’s life, during which soldiers were hit in the head with weapons.

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Thus the study of MEDICINE began for mankind. Along with the Magical-Sacral beliefs, the patient case studies included description of the injury, examination of the patient, diagnosis, prognosis, and treatment.

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Treatments included: spells, incantations, suturing, bandaging, splinting, and the application of poultices. Imhotep’s observations recorded descriptions of the brain, and other cranial structures, meninges (coverings of the brain) and cerebrospinal fluid. Even though magical and prayer modes of healing were present, some modern methods of medical practice of today were emerging, as exemplified by patient observation and examination, simple treatment forms, and the recording of the findings (the first medical records). Maybe that’s why doctors still write in hieroglyphics!

John Zettelmaier, MD is a graduate of the University of Michigan Medical School, a member of the Beta Beta Beta Biological Honor Society, an American Board of Family Practice Diplomate, an American Academy of Family Physicians Life Member and Fellow, and a Life Member of the Michigan Academy of Family Physicians.

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